Fine Print: “Doctors: Best of 2013” List Does Not List the Best Doctors

Here is a piece that I wrote exclusively for publication on LinkedIn (but you can read it without an account, I believe).

It's not strictly “Lean” related, but I think it does speak to questions about the changing way customers (patients) will choose value (cost or quality in healthcare). As real quality and cost data becomes available to the public and patients can share their experiences without filters, will these lists go away?

Yes, This is what drives the lean experts from manufacturing working in healthcare crazy. Quality, cost, and delivery are pretty much the only things that count in manufacturing. For the most part, these aspects of healthcare are pretty much either indeterminable, invisible, or unimportant compared with “other” unexpressed and inexpressible aspects of customer requirements.
I did a short training exercise for an outpatient service once where customer requirements included things like “a garden atmosphere” and “aroma of premium coffee” in the waiting area and things like a lower false positive rate and cost of the procedure never even came up.
Not that we shouldn’t provide, but good luck value stream mapping “premium coffee aroma”.

I can’t remember the source, but I remember learning about the idea that customers are overmatched when trying to gauge the quality of a professional – that can include lawyers, electricians, doctors, and even lean consultants. If they don’t understand enough (or don’t have enough data) to gauge functional quality, customers fall back on superficial things. Was the electrician on time? Was the doctor nice? Did the lawyer return my calls?

Maybe that’s why patients are so (apparently) impressed with marble flooring and fountains in hospital lobbies?

If it’s impossible to get consensus on what the best cars are on the market (based on defect data, car appearance, sales #’s, etc), what hope do we have of knowing, for a fact, who the top doctors are?

Do patients rate doctors highly because they easily give out antibiotics or pain meds when asked? There is a study out that says the idea of patients rating doctors is actually BAD for quality and outcomes, because the docs are too scared to push back when a patient wants the wrong treatment or tests.

Do the doctors know or care who the best specialists arew?

My primary care physician recently referred me to a specialist. I figured it was because the specialist was really good. Turns out the specialist (he volunteered this, not out of disclosure, but chattiness) that his wife works at the GP’s office (or something). So, maybe the referral wasn’t based on anything close to “who is best?” So, how am I supposed to determine?

Then again, I chose my PCP because they take my insurance and they are reasonably close to my home. I had nothing better to go on to make my choice.

Until we have good data out there, we’re all just grasping at straws, it seems, with magazine lists or otherwise.

A reader, who wanted privacy (but agreed to have it shared in this form) wrote the following:

Did you know that some doctors solicit votes, letters, and testimonials directly from their patients in order to win these best doc and people’s choice contests? I know this because my wife is a [redacted specialty] doctor, and one of the other [redacted]s in the community who is not good is well-known for this behavior. But then, there’s no body that oversees quality in specialists at some community-based hospitals — at ours in particular. So consumers are taking their chances if they use popularity contests to choose their physician.

I previously worked for a large primary care group in the Denver area that held an internal nomination process for the 5280 Top Doc award each year. The group chose their own “top doc” (a different one each year) and then instructed all the physicians in the group to enter their vote in the magazine’s official nomination process for that person, essentially stuffing the ballot box. It was not surprising that the group had a physician listed each year as the Top Doc. If only patients knew that in some cases the main criterion for election was not quality of care but rather a dishonest marketing ploy.

I provide marketing services for physicians and it’s always a source of contention as to whether we should participate in these or not. Sure, they’ll list your name for free but if you want your practice recognized with a picture and blurb then you have to pay (and it’s not cheap)! However, my doctors often participate because they feel obligated. They feel like patients expect to see them there and it’s good p.r. I don’t disagree with that but I hate the fact that they end up paying all this money just out of obligation. That part I don’t agree with but it’s their choice at the end of the day. Seems like these best doctor’s list are merely an additional source of revenue for the publications, and nothing more. I feel bad for the doctors who aren’t listed – almost as if we’re implying that they are NOT good doctors just because they didn’t make the cut. We all know that’s the furthest from the truth.

Two magazine people complained that I had it wrong, including this one:

Respectfully I have to disagree with your take on these awards and your reading of the fine print. These recognitions are important, they are often selected based on the views of many physicians in the local community. The opinions of physicians are a compelling source. For example, if you need surgery and your family friend is a doctor, do you care who she recommends? Yes, you do. In my experience, bad doctors are not held in high esteem and do not get these awards. Is the award a sure bet, no. That’s what the fine print says, and that’s really all it says. The fine print says “don’t sue us if you have a bad experience.” Why does it say that? Not because the recognition is meaningless, but because patients sue even the best doctors. Plus, it would be false advertising. They are just making clear they aren’t the FDA or some other regulatory body. Also, you can’t pay to get on these lists, despite some comments to the contrary.